CHRONIC ILLNESS

Lisa James at her daughter, Nikkia's monthly six-hour sickle-cell anemia treatment to reduce iron in her blood. (Meggan Booker photo) LISA JAMES 39, Blue Ash Type of insurance coverage: Employer-offered managed care plan Health coverage premium: About $600 a month for family coverage Family health bills: Thousands per year for care related to sickle cell anemia

Like one of every 500 African-Americans, Lisa James was born with sickle cell anemia. So were two of her five siblings. So was her 19-year-old daughter, Nikkia.

Even though her condition is in generally good control, Lisa still requires regular monitoring, occasional blood transfusions and hospital care during painful "flare-ups" of the blood disorder.

For many years, nearly all her bills were covered by health plans provided by her husband's employers, General Electric and Belcan Corp. But when he took a new job in Michigan, it turned into a coverage nightmare so serious he moved back to Cincinnati.

"We started getting a whole bunch of bills. Thousands of dollars. We paid for some of them with our income tax returns. We're still paying for some of them," Lisa James says.

The couple has since divorced, but she remains covered through his employer.

Paying the high costs of chronic illness is one of the toughest problems in health benefits today.

More than 36 percent of large employers are considering disease management programs to pay for preventive care before complications lead to expensive hospital stays.

But most people work in jobs where the health plan doesn't pay for preventive care or limits coverage of maintenance supplies.

James says she now appreciates her coverage. "It didn't dawn on me how much we were blessed with good benefits," she says.

More stories from Greater Cincinnati families: Chronically ill or 'ridiculously healthy." Workers, self-employed or retired. Young or old. A spectrum of lifestyles and incomes. But these Greater Cincinnati families share a worry about the cost of health care, now and in the future. SMALL BUSINESS OWNER Risk of going bare vs. impossible costs Harry Tyson started a company after the dot.com bust, but health benefits have been impossible. YOUNG PROFESSIONAL Satisfied for now, unsure about later Though happy with his coverage, Rich Hancock worries as his parents spend more for health care. CHRONIC ILLNESS Insurance changed and bills soared When Lisa James' husband took a new job, it turned into a coverage nightmare. UNION WORKER A strong benefit that may not last Keith Glassmeyer says health-care benefits are the biggest concern among fellow workers. CONCERNED SENIOR No confidence in Medicare reform Betty Stevens joined an HMO in the '90s, and saved money at first. She's now less satisfied. RETIRED EXECUTIVE 'On the good end,' but still worried Bill Luerssen is "ridiculously healthy" and lucky to have solid benefits. Not all retirees are so lucky. • More stories from Greater Cincinnati residents • Add your own story or comment